Provider Demographics
NPI:1609173616
Name:LOPEZ, NADIUSKA GISSELLE (DC)
Entity type:Individual
Prefix:MRS
First Name:NADIUSKA
Middle Name:GISSELLE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 AVE LOS PINOS
Mailing Address - Street 2:URB. LA ESTANCIA
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-2040
Mailing Address - Country:US
Mailing Address - Phone:787-505-8224
Mailing Address - Fax:
Practice Address - Street 1:80 AVE LOS PINOS
Practice Address - Street 2:URB. LA ESTANCIA
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-2040
Practice Address - Country:US
Practice Address - Phone:787-505-8224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR489111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor